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Eat Right

Written By

Susan Z. Ritz

Written on

December 06 , 2012

If you haven’t eaten at your local hospital lately, you don’t know what you’re missing. No, seriously! Over the past few years, Vermont medical facilities have traded in their Fry-o-lators for sauté pans, canned and processed foods for local and organic fruits and veggies, and sugary soft drinks for lightly sweetened iced teas. Instead of hot dogs and French fries, many Vermont hospital cafeterias now showcase a well-stocked salad bar sporting signs that inform diners which local farms grew the lettuce, tomatoes, and crudités. At some of the larger hospitals, patients can even order room service and choosing from a menu of locally produced, primarily organic, and antibiotic- and hormone-free seasonal dishes delivered right to their bedsides at almost any time of day.

The impetus behind these culinary changes is the Healthy Food in Health Care Pledge created by Health Care Without Harm, an international organization that promotes green and environmentally sustainable initiatives in health care facilities around the world. The pledge is a broad framework that outlines steps hospitals can take to improve the health of patients and their wider communities while giving local farmers a stable market for their sustainably grown products, leading to a cleaner, healthier environment for all. Since 2005, almost 400 hospitals nationwide have signed the pledge, making a commitment to “first do no harm” by treating food—its production and distribution—as preventative medicine.

According to Alyssa Nathanson, Vermont coordinator of the Healthy Food in Health Care Initiative, “The pledge is a nonbinding, purposely vague document that lays out ideas and suggestions for hospitals to take as they work on creating sustainable food systems right inside their facilities.” Alyssa, who is hosted by Vermont Fresh Network and funded through a grant from Health Care Without Harm, provides technical assistance to the pledged hospitals across the state and builds relationships with their food teams, including dieticians, chefs, and buyers, to help them find ways and means to incorporate healthy, locally produced foods into their operations.

“We focus on baby steps,” she says, “working one-on-one with each facility to figure out what make sense for each individual hospital. We’re not asking them to completely overhaul their systems, just find the things they can reasonably do and are passionate about. It’s about starting small and building on success.” For example, change may be as simple as switching from apples grown in Washington State to apples grown in a nearby orchard. It’s a simple act that has multiple effects, adding fresher food to the menu, educating the larger community and expanding the market for the farmer.

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Since Alyssa came on board in 2008, she has seen Vermont become a national leader in the farm-to-hospitals movement. Currently, 11 out of 15 Vermont hospitals have signed the Healthy Foods Pledge, giving our small state the highest percentage of engaged medical facilities in the country. Vermont’s agricultural heritage, growing network of small organic farms, and commitment to working landscapes have certainly been major factors in creating that success.

Another major factor has been the leadership provided by Fletcher Allen Health Care, which signed the pledge in 2006 and became the third hospital in the nation to do so. Under the creative and dynamic leadership of Director of Nutrition Services Diane Imrie, Executive Chef Richard Jarmusz, Procurement Specialist Scott Young, and their culinary team, Fletcher Allen in Burlington has partnered with more than 70 local farmers and food producers to offer a wide selection of delectable, locally grown meals in their cafeterias and hotel-style, in-patient room service. Fletcher Allen is now the state’s largest restaurant, serving up to 5,000 meals a day that feature hormone- and antibiotic-free meats and dairy products, organic salad and fruit bars, wild-caught fish (mostly from the Northeast), whole-grain breads, and home-baked, low-fat snacks. Its flagship Harvest Café attracts not only staff and visitors but also a growing clientele from the Burlington area who appreciate the wholesome food and reasonable prices.

Through its Center for Nutrition and Healthy Food Systems, Fletcher Allen is also a mover and shaker in the movement to bring local food to hospitals of all sizes across the state and beyond. Working closely with Alyssa Nathanson, Diane Imrie organizes farm visits, workshops, retreats, and other outreach programs for health care center food professionals from Vermont, New England, and the nation. The center also trains culinary staff at other hospitals so they can get the hang of cooking from scratch, using fresh local ingredients rather than the packaged, processed foods most hospitals have relied on for years. These classes encourage staff to step out of their cooking comfort zones and to try some unfamiliar foods, like beet greens and kale. Recently, Diane took a group on a field trip to Gloucester, Massachusetts., to learn about sustainable fisheries, meet the fishermen and discover new ways to incorporate fish into hospital menus. As a follow-up, Fletcher Allen sponsored a seafood “throw down” in October, pitting a number of local medical facilities against each other to see which could come up with the best fish recipe.

In addition, the center’s rooftop garden, beekeeping operation, and weekly farmers’ market (open to the public but primarily frequented by hospital staff) help educate the larger community about the deep-rooted connections between health, nutrition, and sustainable food systems. As Alyssa points out, “Seeing a farmers’ market when you pull up to your doctor’s appointment is a great message,” and it’s one that more and more hospitals are sending.

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Transitioning to healthier foods is not always easy, however. Ginny Flanders, nutrition and food service director at Northeast Vermont Regional Hospital in St. Johnsbury, heard lots of grumbling when she first took Tater Tots off the breakfast menu and replaced them with locally produced home fries. A monthly Meatless Monday option never really took off despite Ginny's’ best efforts to educate her cafeteria customers on the environmental and health costs of daily hamburgers and hot dogs. Undaunted, she and Executive Chef Shawn Hilliker (former chef at Kharma Choling, a Buddhist retreat center nearby) decided to offer more vegetarian entrées and soups on the daily menu instead. “This gives people a choice rather than having it mandated,” says Ginny, who became an early adopter of the Healthy Food Pledge when she signed on in 2008. She is also working on reducing the consumption of sugary sodas, as are many other local hospitals. Instead of banning them altogether, however, she has reduced the size of the drinks offered from 12 ounces to 8. The kitchen also sets out a big container of iced tea each day, as another cost-effective alternative. Customers pay for it only by donation. “This cuts down not just on sugar, but also on plastic bottle waste,” Ginny says.

Education is an integral part of the pledge, so the NVRE cafeteria uses signs on the food to let customers know their meals include items from Vermont vendors such as Vermont Soy, Green Mountain Yogurt, and Bill Half’s Harvest Hill Farm in Walden. “Bill now does a summer CSA for us and about 50 staff have signed up. They can even use their wellness benefits [from the hospital] to pay for it.”

“Overall,” Ginny continues, “we hear very positive feedback. People love to come to the cafeteria because it’s reasonably priced. We can keep the prices low because the hospital supplements us. They trust in what we’re doing. If we are going to be a health care institution, then we need to make food a cornerstone of all we do.”

Of course, health care costs are already high, and local, organic food can certainly increase the bottom line for any hospital food service team. But Jamie Baribeau, director of food and nutrition at Brattleboro Memorial Hospital, has found that he has been able to keep costs at a reasonable level. “It’s actually a cost saver,” he says of the room service meal option. “Patients order what they want instead of getting a standard hospital tray. There’s a lot less waste this way—that’s why a lot of hospitals are going with this approach. Patient satisfaction is very high and we save money at the same time.” Jamie also controls costs by ordering local vegetables when they are seasonally available. The fact that BMH receives its food from 12 to 15 different farms “used to make ordering hard, but now we get [the food] through the Windham Farm Fresh Network, which coordinates deliveries to local schools as well,” he says. The Network aggregates orders, creating an efficient delivery system that cuts both administrative and transportation fees. “Through the Network, we can order online and we can see what even small farms have to offer.”

Since signing the Healthy Food Pledge in 2009, Jamie has adopted a number of innovations, many of which reach well beyond the walls of the hospital, including a seasonal recipe blog and community dinners emphasizing the heart-healthy Mediterranean diet. His Maple View Café is reputed to sell the best clam chowder in the area, as well as freshly baked chicken pies as a take-out item. BMH also has a farmers’ market in front of the hospital where staff and visitors can buy produce and get to know the farmers who grew it. “We’re happy to support the community that supports us,” he comments.

Terry Redmond of Central Vermont Medical Center in Berlin echoes this sentiment: “Hospitals need to be leaders, not followers, in the localvore economy.” Terry signed the Healthy Food in Health Care Pledge in 2010 after already having made many modifications, such as getting rid of steam tables and Fry-o-laters. He is proud to say that CVMC’s Mountain View Café “has the best salad bar in the area,” stocked with produce from the Two Rivers’ Center’s Farm-to-Table program. It also features a broad selection of entrées and seasonal soups prepared by Executive Chef Justin Turcotte, Kitchen Manager Shawn Wolf and their staff trained at the New England Culinary Institute. NECI also helps design and evaluate the food selections.

This year Terry has focused on upgrading in-patient service through “Room Service 4 You,” which operates much like Fletcher Allen’s. Patients’ nutritional needs are evaluated when they enter the hospital and their made-to-order meals are designed to address their medical needs. “Patient menus offer entirely local entrées, with grass-fed local beef, Manghi’s and Red Hen bread, and shrimp from Maine," says Terry Redmond of Central Vermont Medical Center in Berlin. "We even try to add a bit of ethnic heritage by cooking French and Italian meals.” Black River Produce, which combines orders from Vermont farms and delivers to many local schools as well as hospitals, helps make local buying easy.

•••

Besides offering the benefits of health and environmentally sound practices, local foods in hospitals can also offer comfort, especially to many of Vermont’s elders. Alyssa Nathanson points out that many of the older patients at Gifford Hospital’s skilled nursing facility in Randolph used to be farmers themselves. They remember the days when eating local was the only option and they are happy to see the names of farms that have been around for generations on their daily menus. Residents of Wake Robin in Shelburne, which became the state’s first retirement community to sign the Healthy Foods Pledge in 2011, are also passionate about going local. A gourmet dinner series, as well as a locally based menu in the restaurant and cafeteria, introduces this lively bunch of seniors to new trends in agriculture and helps them feel vitally connected to local farms.

There are still some areas in which each hospital would like to grow and improve. Reducing waste, expanding compost programs, and continuing to wean clientele off sugary sodas are all common goals for the near future. And Fletcher Allen is working on ways to track the long-term quantitative health benefits of this new approach to hospital dining, again leading the nation with its evolving evaluation practices. In the meantime, Vermont’s hospitals are working hard to dispel old myths about hospital food. They invite us all to stop in and taste for ourselves the big difference that the Healthy Foods in Health Care program has already made.

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About the Author

Susan Z. Ritz lives in Montpelier where she is a freelance writer and creative writing teacher. She has previously served on the boards of several Vermont arts, environmental, and women’s advocacy groups but is currently hard at work on her first novel.

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